Kentucky Gov. Matt Bevin warmed to the Medicaid expansion in the 2010 health care overhaul quickly after taking office last month.
At a Dec. 30 press conference, Bevin — a Republican who narrowly won his party’s primary and was elected by a wide margin in November — announced he plans to keep the Obamacare expansion in place, albeit with some tweaks that may or may not be acceptable to federal regulators.
Mimicking a tactic of Republican supporters of the Affordable Care Act in other states, Bevin called for adjustments to Medicaid expansion as part of broader reforms to make Kentuckians “as undependent as possible” on welfare spending.
Obamacare’s Medicaid expansion adds childless, able-bodied, working-age adults to a program previously meant for pregnant women, the elderly, the disabled, children and impoverished families. More than 400,000 Kentuckians have enrolled in the welfare expansion since January 2014.
During his campaign, Bevin pledged to roll back the Medicaid expansion his Democrat predecessor, Steve Beshear, implemented without the Kentucky Legislature’s approval.
“No question about it, I would reverse that immediately,” Bevin said in February.
“The Medicaid expansion enacted under Obamacare is unaffordable for the taxpayers of Kentucky and should be repealed,” Bevin’s campaign platform stated.
Now, Bevin is working with the Obama administration and University of Kentucky HealthCare executive Mark Birdwhistell to develop Medicaid expansion waivers for approval by the federal Centers for Medicare and Medicaid Services.
Obama’s CMS consistently rejects waiver requests adding work requirements or cost sharing to Medicaid, but Birdwhistell — a former Kentucky Cabinet for Health and Family Services secretary — is optimistic.
“To me, I’m enticed by trying to do something that is the latest and the greatest,” Birdwhistell said at the December press conference. He and Bevin repeatedly mentioned 1332 waivers, a provision of Obamacare they hope will help customize Kentucky’s Medicaid expansion.
Bevin made it clear he sees Indiana Gov. Mike Pence’s Healthy Indiana Plan 2.0 as a model for Kentucky to build on, although CMS blocked several of Pence’s proposals for the program.
Pence used HIP 2.0 as political cover for his own Obamacare expansion; in many ways, HIP 2.0 undercut reforms included in the original Healthy Indiana Plan.
“We are going to submit to CMS a solution that we are going to work with them on,” Bevin told reporters, describing a slightly modified Medicaid program as the equivalent of a federal block grant.
Bevin said he cannot predict whether the Obama administration will grant any waivers Kentucky requests, but he expects to know by mid-2016. Approved Obamacare 1332 waivers would not take effect until Jan. 1, 2017, at the earliest.
If his administration is unable to secure waivers from CMS, Kentucky will “continue to move forward under the structure that we currently have,” Bevin told reporters. But later during a question and answer session, Bevin seemed to indicate he would freeze Obamacare expansion enrollment in 2017 if the waivers his administration asks for aren’t granted.
The governor’s office did not respond to a request for clarification from Watchdog.org.
Julia Crigler, state director for Americans for Prosperity Kentucky, told Watchdog.org Bevin will have his work cut out for him selling Obamacare expansion changes to grassroots conservatives.
“Kentuckians understand how Gov. Beshear’s expansion of Medicaid has hurt the state and any continuation of expansion will raise serious questions regarding the program’s financing and effects, especially if the promise to bring market-based reform is to be kept,” Crigler said.
“It’s important that the governor clearly articulate his proposed reforms if he wants the grassroots to support those measures,” she added.
A December poll from free-market group FGA Action found widespread opposition to Obamacare expansion among Kentucky voters.